Laparoscopic Assisted Appendectomy - Comparative Study (Abstract)

Objectives: The paper presents the results of a comparative study between laparoscopic-assisted appendectomy (LAA) and open appendectomy (OA) in the treatment of acute uncomplicated appendicitis in paediatric patients.Material and methods: The results of 110 LAA and 120 OA, in patients with a preoperative diagnosis of acute uncomplicated appendicitis are compared. LAA was performed using a 10mm trocar inserted in the umbilicus, following an open procedure; through it a telescope with operative channel was inserted. After exteriorization of the appendix through the umbilical incision,appendectomy with inversion of the stump was performed outside the abdomen.Results: Conversion was performed in 5 cases (4,5%), from LAA group. An additional 5mm trocar was introduced in 10 cases (9,1%). The conversions were for gangrenous perforated appendicitis in 2 cases (1,8%) and for intense peritiphlitis in 3 cases (2,7%). An additional trocar was introduced in 8 cases (7,3%) for mobilization of fixed appendix, and in 2 cases (1,8%) for thetreatment of associated cystic pathology. There were no intra or postoperative complications. Cosmetic results were very satisfying. In OA group, enlargement of the incision was necessary in 13 cases (10,8%): ectopic appendix in 11 cases (9,2%) and gangrenous perforated appendicitis in 2 cases (1,7%). There were 2 cases (1,7%) of wound infections.Conclusions: LAA is a viable technique alternative for treatment of acute uncomplicated appendicitis in paediatric patients. Laparoscopic inspection of the whole peritoneal space, reduced parietal trauma, very good cosmetic results, together with a decreased rate of complications, imposed LAA as an excellent method of treatment, especially in ectopic appendix, obese patients and in cases of diagnosis doubts.